Can Medical Cannabis Be used as a Anorexia Treatment Hero

A characteristic feature of cannabis is that it causes the “munchies,” which begs the question: could cannabis be used to treat anorexia nervosa? Cannabis has been widely studied as a treatment for anorexia (or cachexia) associated with cancer and HIV/AIDS. However, there’s little research on whether it would be an effective treatment to treat the type of anorexia that most people are familiar with: anorexia nervosa.

It’s unfortunate so little research has been done given how many people are affected and what the consequences are of leaving anorexia untreated. According to the National Eating Disorders Association (NEDA), 20 million women and 10 million men will develop an eating disorder at some point in their lives, with anorexia being one of the most common disorders. Among college students, the numbers are even more staggering: the National Institute of Mental Health estimates 25% of college students suffer from an eating disorder. Left untreated, the consequences can be dire. Anorexia has the highest mortality rate (12.8 percent) of any psychiatric disease. A shocking 6 percent commit suicide.

What is Anorexia Nervosa?

According to NEDA, anorexia nervosa is “a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.” Extremely low body weight, body dysmorphia (a distorted perception in body image), an obsession with counting calories, and an excessive need to control one’s environment are all common among sufferers. Individuals also often base their sense of self-worth on their body weight and shape, and have difficulty finding pleasure in activities that most people consider enjoyable.

What Are the Causes of Anorexia?

Historically, the causes of anorexia have been attributed to sociocultural factors such as childhood trauma or family members’ (and society’s) attitudes towards the desirability of thinness and slimness. However, evidence has emerged in recent years that also underscores the role of genetics and neurobiological factors.

Can Medical Marijuana Treat Anorexia?

The idea that cannabis could help treat anorexia seems like a no-brainer. After all, not only is cannabis notorious for inducing the “munchies,” but research on cannabis as an appetite stimulant for those suffering from cancer or HIV/AIDS has validated cannabis’s effectiveness. However, when it comes to anorexia nervosa, we only have a few studies. Only a handful of states consider anorexia a qualifying condition for medical cannabis, but many include related issues like uncontrolled weight loss, anxiety, and nausea.

Nonetheless, given the research we have accumulated, anecdotal evidence, and the fact the endocannabinoid system — the body’s own cannabinoid system — exerts such a powerful influence on appetite, cannabis as an anorexia treatment is highly plausible.

A 2011 Belgian study suggests that because dysfunctional regulation and underlying imbalances within the endocannabinoid system are prominent across eating disorders, developing cannabinoid-derived treatments (targeting the endocannabinoid system) could prove therapeutically valuable. The study offers promise that cannabinoids could help correct endocannabinoid deficiencies, while helping the individual return to a healthy state. However, this was a small study, and clearly more research is warranted.

In 2014, European neuroscientists conducted an important animal study offering another possible explanation on why cannabis (or specifically THC) may be useful in treating anorexia. Anorexia sufferers lose the ability to find pleasure in activities, particularly eating. And, authors of the study found that the way THC activates the endocannabinoid system’s CB1 receptor (one of two identified receptors) elevates pleasure in eating by increasing our sensitivity to smells and taste.

A human study hailing from the Center for Eating Disorders at Odense University Hospital in Denmark provided encouraging data (although, with just 24 subjects, the study was fairly small). In this study, patients were given a placebo or dronabinol (a synthetic form of THC). On average, patients gained 1.6 lbs more on dronabinol than the placebo. The authors noted the treatment was “well tolerated” with “few adverse events.” Further, researchers followed up with patients a year after starting treatment and determined patients were still improving their symptoms and nutrition while showing no signs of addiction or withdrawal issues.

Mainstream is Still Not Convinced

The mainstream medical community, however, has thus far remained unconvinced. According to Tamara Pryor, director of clinical research at the Eating Disorder Center of Denver, individuals suffering from anorexia are empowered by not succumbing to the temptation of eating, so “stimulating their appetite can’t necessarily overcome the neurobiological issues that are also intimately involved with their disorder.” That being said, Pryor notes, “Marijuana may be a helpful tool for some people — in conjunction with therapy.” By therapy, she’s referring to cognitive behavioral therapy (CBT), which is accepted as one of the most effective forms of treatment.

Likewise, more often than not, anorexia accompanies other psychiatric disorders, particularly anxiety-related disorders. While cannabis may be helpful in treating comorbid conditions, could a patient’s perceived relief from other symptoms (e.g. insomnia or anxiety) increase the risk that they develop a dependency disorder? On the other hand, could strains high in non-intoxicating CBD (which has no reinforcing, habit-forming properties) provide relief, while reducing dependency risk?

While mainstream medicine may not yet be convinced, unsurprisingly, there is no shortage of people who credit cannabis with helping them overcome anorexia. A clinical cannabis patient from Los Angeles, Sarah (who for confidentiality reasons declined to use her real name), told Leafly that for years she struggled with anorexia. Doctors gave her antidepressants and anti-anxiety drugs, which she says helped her with some of her issues, but did nothing to help her kick anorexia to the curb.

“I tried for years to overcome anorexia and bulimia. For me, anorexia was a way to fulfill my need for control over my life. I was never much of a pot user, but recalling how [cannabis] gives you the munchies, I decided to give it a shot,” says Sarah. “It worked remarkably well. I became less self conscious, I lost my obsession over counting calories, and I started enjoying food again.”

Sarah claims cannabis provided a “short-term solution to a long-term problem.” She claims that within six months she beat anorexia. She now consumes only occasionally. “I haven’t totally gotten over my body issues, and that most often becomes an issue during intimacy with my fiancé. So now I’ll occasionally medicate and I’ve found that I’m far less self-conscious and it brings us closer.”

While cannabis may provide a valuable alternative treatment for anorexia, cannabis should not be seen as a panacea. It may serve a role, but given the seriousness of the condition (including the high mortality rates), consulting a specialist and enlisting support through peer groups is vital. Two organizations, NEDA and National Association of Anorexia Nervosa and Associated Disorders (ANAD), provide valuable online resources to individuals or loved ones impacted by anorexia.

While it may be some time before mainstream medicine embraces cannabis as part of an overall treatment program for anorexia, clearly it hasn’t stopped patients in states where it is (and isn’t) a qualifying condition. However, while research continues to shed light on how cannabis may or may not play a role in recovery, prospective patients should consult a professional and carefully consider the pros and cons of cannabis as a treatment before embarking on a cannabis-based treatment regimen. Also, keep in mind that dosing, strains, intake methods (e.g. vaping, tinctures, edibles), can all influence outcomes. So it may take a little trial and error to find what works best.

https://www.usatoday.com/story/news/nation/2012/12/27/college-kids-eating-disorders/1794057/

 

Verty, A. N., Evetts, M. J., Crouch, G. J., McGregor, I. S., Stefanidis, A., & Oldfield, B. J. (2011). The cannabinoid receptor agonist THC attenuates weight loss in a rodent model of activity-based anorexia. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 36(7), 1349–1358. https://doi.org/10.1038/npp.2011.19

 

Chadda, R., Malhotra, S., Asad, A. G., & Bambery, P. (1987). Socio-cultural factors in anorexia nervosa. Indian journal of psychiatry, 29(2), 107–111.

 

https://www.biologicalpsychiatryjournal.com/article/S0006-3223(11)00507-5/fulltext

 

https://www.nature.com/articles/nn.3647

 

https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.22173

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This article written by Jeremy Kossen was originally posted on Leafly.com.

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Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

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Medical Cannabis Users Beware! Drug Interactions You Need to Know About

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Brain

written by

Namen Namestein

Brain

reviewed by

Namen Namestein

If using cannabis while taking other medications has you questioning their interaction- I applaud your good thinking. Just like adding a new prescription to your daily medication regimen there is concern for possible drug interactions, which holds true of cannabis as well. Afterall, cannabis is medicine, though to avoid negative side effects and medication counteracting from prescription drugs, cannabis needs to be considered as a potential factor in causing those effects through its process of metabolization resulting in possible effects.

Now, let us break down medication interactions and what you may need to be more aware of when medicating with cannabis. We will review the different kinds of side effects, what to avoid to prevent them, certain kinds of medication you shouldn’t take with cannabis, and other other things to manage adverse drug interactions.

Types of Drug Interactions

As all drugs can cause an array of reactions- some benign and others serious- it is important to know about possible drug interactions. The effectiveness of drugs can be increased or decreased when combined with another drug or substance. These are the threes types of drug interactions take may be cause for concern:

💊 drug-drug interactions occur when two or more drugs react with each other, which includes prescription, over-the-counter, and illicit drugs. This is of utmost concern with drugs that have a narrow range between therapeutic and lethal doses.

💊 drug-food interactions occur when drugs react with foods, dietary supplements and/ or beverages. Some drugs may also interfere with the body’s ability to absorb nutrients. 

💊 drug-disease interactions occur when a drug exacerbates or worsen an existing medical condition. High risk conditions for drug interactions include:

✱ kidney disease 
✱ liver disease 
✱ diabetes 
✱ asthma
✱ cardiac problems
✱ epilepsy
✱ high blood pressure
✱ low blood pressure 

Types of Drug Interaction Effects

Drug interaction predictors enable risk assessment of drugs. The dreaded side effects of medication are actually broken down into three types and it is important to understand the difference between each to know how best to manage them. Here are the definitions and  differentiating factors of additive, synergistic, and antagonistic effects:

✳️ additive effects of drugs produce a reaction created by causative factors acting together as the sum of their individual effects. Simply put- that means the two chemicals work together to equal the sum of their parts. The impact of the two or more drugs together adds scientific value to the predicted outcome. Elements essentially added to each other’s intended outcome chemically and biologically.

✳️ synergistic effects refers to the effect of two chemicals interacting creating a greater reaction than using one individually. The interaction adds to the strength to the effect of the medicine. When chemicals are synergistic, the potential hazards of the chemicals should be considered and re-evaluated.

✳️ antagonistic effects speaks to the instance when two or more drugs are combined to produce a weaker, decreased, or opposite effect on the body. Drug antagonism may block or reduce the effectiveness of one or more drugs.

Cannabis Drug Interactions

If you plan to use cannabis medicinally, chances are you are already on a course of other medication. Common uses of cannabis often include diagnoses of cancer, chronic pain, epilepsy/seizures, nausea and vomiting, muscle spasms, inflammatory conditions, Alzheimer’s, and Parkinson’s diseases. The wide range of uses increases the likelihood of potential drug interactions as most of these diagnoses affect individuals who require numerous medications combinations due to age or illness. All the more reason to review the drug interaction considerations when medicating with cannabis.

The following drug-drug interactions are cause for concern when using cannabis

🚩 opioids may allow for lower opioid doses while reducing risk of dependency and fewer side effects. 

🚩 sedatives (benzodiazepines, antidepressants, barbiturates, narcotics) produces an additive effect with cannabis increasing sedative effects.

🚩 blood sugar medication could be a risk when cannabis is combined as glucose levels could significantly drop causing a medical emergency.

🚩 blood pressure medication may compound effects by activating receptors to induces a cardiovascular stress response that can elevate cardiac oxygen consumption while reducing blood flow in coronary arteries.

🚩 blood thinning medication effectiveness’ may be augmented possibly slowing down the metabolism of these drugs. 

🚩 heart rhythm medication with cannabis may amplify its affect and change the heart rhythm.

🚩 thyroid medication may compete with cannabis in the cytochrome P450 pathways to be metabolized.

🚩 seizure medication may induce seizure if not properly used with cannabis.

🚩 alcohol …uh, yeah. Alcohol is a drug. When combined with cannabis these substances may result in very different reactions depending on many variables including which one you use first and how you consume them. 

There are some drugs that are of utmost concern as their interaction with cannabis could be fatal. Potentially serious drug interactions include:

⚠️ warfarin

⚠️ amiodarone

⚠️ levothyroxine

⚠️ clobazam

⚠️ lamotrigine

⚠️ valproate

Tips to avoid adverse effects from drug interactions

There is clearly lots to know to mitigate the risks involved with drug interactions. To best prepare yourself for medical cannabis use and to decrease the risk of interactions, consider these tips: 

🔹 Know your own medicines. Be sure to read about the medication prescribed and any interactions to consider.

🔹 When you see your doctor, be sure to inform them about all the drugs you are taking. These should include over-the-counter medications, vitamins, dietary supplements, herbal remedies, cannabis, CBD, and any medicinal substance.

🔹 Keep your list of medications up to date, which is particularly important if you visit more than one doctor or pharmacy.

🔹 Ask your doctor or pharmacist what to avoid- medications / food/ beverages…

🔹 Take medication as instructed and learn about possible side effects. Be sure to make your medical providers aware of any side effects you experience.

🔹 Review your medications regularly to eliminate unnecessary ones as interactions increase when medication variety increases.

🔹 Do your own research! Not every doctor and/or pharmacist is up on the latest cannabis info. You, too, can take some responsibility for your treatment. Consider looking up your medicine interactions with MedScape, Drugbank, and any other online resources offering updated info on pharmaceuticals + cannabis.

In Conclusion

Cannabis has the potential to interact with many medications, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be administered in combination with cannabis while others may need modification or reduction to prevent serious issues. Cannabis may increase or decrease the effectiveness or potency of other drugs. Though always consult your doctor before tampering with your regimen. 

All interactions considered, everyone should inform healthcare professionals should be informed of any condition(s) and/ or medications / dietary supplements being administered during a doctor’s visit or when purchasing medicines at the pharmacy. Yup, that means cannabis, CBD, and any form of chemical compound derived from it. Cannabis, like every other medication, must be considered when ANY medical professional is treating you. Stay safe potential cannabis users!

https://news.gallup.com/businessjournal/170696/win-natural-talent-additive-effects.aspx

https://www.fda.gov/drugs/information-consumers-and-patients-drugs/you-age-you-and-your-medicines

Alsherbiny, M. A., & Li, C. G. (2018). Medicinal Cannabis-Potential Drug Interactions. Medicines (Basel, Switzerland), 6(1), 3. https://doi.org/10.3390/medicines6010003

Aronson J. K. (2004). Classifying drug interactions. British journal of clinical pharmacology, 58(4), 343–344. https://doi.org/10.1111/j.1365-2125.2004.02244.x

Cascorbi I. (2012). Drug interactions–principles, examples and clinical consequences. Deutsches Arzteblatt international, 109(33-34), 546–556. https://doi.org/10.3238/arztebl.2012.0546

Jiang R, Yamaori S, Takeda S, et al. Identification of cytochrome P4540 enzymes responsible for metabolism of cannabidiol by human liver microsomes. Life Sci. 2011;89:165-170.

Rebecca L Hartman, Timothy L Brown, Gary Milavetz, Andrew Spurgin, David A Gorelick, Gary Gaffney, Marilyn A Huestis, Controlled Cannabis Vaporizer Administration: Blood and Plasma Cannabinoids with and without Alcohol, Clinical Chemistry, Volume 61, Issue 6, 1 June 2015, Pages 850–869, https://doi.org/10.1373/clinchem.2015.238287

Toennes SW, Schneider K, Kauert GF, Wunder C, Moeller MR, Theunissen EL, Ramaekers JG. Influence of ethanol on cannabinoid pharmacokinetic parameters in chronic users. Anal Bioanal Chem. 2011 Apr;400(1):145-52. doi: 10.1007/s00216-010-4449-2. Epub 2010 Nov 30. PMID: 21116612.

Lukas SE, Benedikt R, Mendelson JH, Kouri E, Sholar M, Amass L. Marihuana attenuates the rise in plasma ethanol levels in human subjects. Neuropsychopharmacology. 1992 Aug;7(1):77-81. PMID: 1326277.

Yurasek, A.M., Aston, E.R. & Metrik, J. Co-use of Alcohol and Cannabis: A Review. Curr Addict Rep 4, 184–193 (2017). https://doi.org/10.1007/s40429-017-0149-8

Ramaekers, J. G., Theunissen, E. L., de Brouwer, M., Toennes, S. W., Moeller, M. R., & Kauert, G. (2011). Tolerance and cross-tolerance to neurocognitive effects of THC and alcohol in heavy cannabis users. Psychopharmacology, 214(2), 391–401. https://doi.org/10.1007/s00213-010-2042-1

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Cannabis and Mental Health: Harm Reduction Strategies

There is a well-documented link between cannabis and the onset of psychosis in vulnerable individuals. Typically, guidelines recommend that people with a history of mental illness, either individually or in their family, should avoid cannabis at all costs. Approximately 1 in 5 Canadians and Americans experience a mental health condition each year, and approximately 1 in 33 Canadians will experience psychosis in their lifetime, with similar numbers in the States.But is abstinence the only option? Or might there be some middle ground, where people can consume cannabis while taking measures to protect themselves?

There is little consensus on the specifics of the complicated relationship between cannabis and mental health, although the association between cannabis use and mental illness is well-documented. Some experts staunchly insist that cannabis causes mental illness, while others believe the data reflects the fact that people with a predisposition to mental illness are more likely to be attracted to cannabis.

But what almost everyone can agree on is that people with a personal or familial history of mental illness, in particular, psychosis, should take action to reduce harm if they do choose to consume cannabis.

There are many choices that can reduce potential mental health risks of cannabis consumption.

What are the mental health risks of cannabis?

The main mental health risk of cannabis consumption is developing psychosis, the experience of losing contact with reality. The symptoms vary among individuals, but may include unusual thoughts, seeing or hearing things that are not there, and paranoid or delusional beliefs.

While THC can cause paranoia in people without mental illnesses, the evidence suggests that those who develop full-blown psychotic illness in response to cannabis use were likely predisposed to it in the first place.

There is also some evidence suggesting that people who have mental health vulnerabilities may be more likely to try cannabis, rather than cannabis causing their mental illness.

Depression and heavy use of cannabis are also associated, but similarly, it is unclear if the association is causal, or if shared factors may increase the likelihood of both cannabis consumption and depression.

Strategies for lower risk cannabis consumption

Most physicians recommend a person abstain from cannabis if they have a personal or family history of mental illness. If someone chooses to consume cannabis anyway, there are a few ways to reduce harm.

The Centre for Addictions and Mental Health (CAMH), along with Health Canada, has produced a set of lower risk cannabis use guidelines.

The guidelines explain that abstinence is the most effective way to avoid the psychiatric risks of cannabis. In addition, they suggest delaying the use of cannabis as long as possible, and ideally until after adolescence.

Dr. Romina Mizrahi, MD, professor of psychiatry at the University of Toronto, and director of the Focus on Youth Psychosis Prevention program at CAMH explains:

“The key issue, I think, here really has to do with brain development,” she says. “One would want to minimize use before the brain is developed. And I would usually say ideally until 24 or 25. But I mean, it has to be after the age of 21, for sure.”

The guidelines also recommend people opt for cannabis with lower THC content overall, and a higher CBD to THC ratio.

Dr. Mizrahi emphatically agrees.

“We know that THC is associated with psychotic experiences, and we also know it’s associated with abuse and dependence. So certainly I want to make that recommendation that when people have to choose, they attempt as much as possible to use a minimal THC content.”

Finally, the guidelines suggest that people with a family history of psychosis should not consume cannabis at all.

If you have a first-degree relative—a mother, father, brother, sister, or child—who has experienced a psychotic disorder, it is worth being extra cautious.

Your risk is higher the more closely you are related to the affected individual. For example, the risk of schizophrenia is 6.3x higher in those with an affected first-degree relative, and 2.4x higher in those with an affected second-degree relative. Second-degree relatives include aunts, uncles, nieces, nephews, half siblings, grandparents, and grandchildren.

Dr. Kim Lam, MD, a patient educator at Apollo Cannabis Clinics in Toronto, has some additional advice to offer.

Lam suggests patients with any history of mental illness use the “start low and go slow” rule. This means starting with a low dose of cannabis, and increasing it slowly to reduce the risk of side effects.

When asked about how cannabinoid content can impact a person’s experience, Lam’s clinical experience lines up with the CAMH guidelines.

“Cannabis with a higher CBD content and lower THC content can reduce harm in a mental health context,” Lam said.

“Because THC is psychoactive, and CBD has been shown to help diminish the side effects of THC, we often like to start patients on just CBD, and add THC only if needed.”

Importantly, people with mental health vulnerabilities who choose not to abstain from cannabis can still make choices to reduce the risk to their mental health.

Here are some harm reduction strategies for cannabis consumption:

      • Consider abstinence. Abstinence is the best way to avoid the mental health risks of cannabis consumption. Consider this more strongly if you have a close relative who is affected by psychosis.
      • Delay use until after adolescence (age 21). Cannabis is thought to affect teens’ brain development, which may account for some of the mental health risks.
      • If you choose to consume, select cannabis with lower THC content overall, and cannabis with a higher CBD to THC ratio. Avoid illicit cannabis, which is not tested.
      • Start low and go slow to reduce the risk of side effects. If you have a distressing mental experience while using cannabis, stop consuming it temporarily and seek help.
Leafly logo

This article written by Laura Tennant was originally posted on Leafly.com.

Chou, I. J., Kuo, C. F., Huang, Y. S., Grainge, M. J., Valdes, A. M., See, L. C., Yu, K. H., Luo, S. F., Huang, L. S., Tseng, W. Y., Zhang, W., & Doherty, M. (2017). Familial Aggregation and Heritability of Schizophrenia and Co-aggregation of Psychiatric Illnesses in Affected Families. Schizophrenia bulletin, 43(5), 1070–1078. https://doi.org/10.1093/schbul/sbw159

https://www.schizophrenia.ca/docs/SSC%20and%20SSCF%20Annual%20Report%20for%202017-2018.pdf

Louisa Degenhardt, Wayne Hall, Michael Lynskey. Exploring the association between cannabis use and depression. Addiction: 98 (11), 1471-1640, (November 2003).

Morrison, P., Zois, V., McKeown, D., Lee, T., Holt, D., Powell, J., . . . Murray, R. (2009). The acute effects of synthetic intravenous Δ9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychological Medicine, 39(10), 1607-1616. doi:10.1017/S0033291709005522

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

A proclame to fame is the common phrase; “I have such a type..” which can link to a magnitude of preferences in someone’s life. Though for some, when it comes to “a type” of strain found in cannabis, the pressure is on to pursue the relief again. Though here is the problem, solely searching for this strain without considering the brand can lead to a completely different experience than before. You may notice differences in the flower with the smell, taste and/or burn, so to avoid this for the future, we must consider the key three factors to successful types of strains:

🧬 phenotypes

🧬 genotypes

🧬 chemotypes 

When we consider the lineage of cannabis, which just like any plant, has been adapting over time to accommodate its habitat, we are left to dive deeper into education on cannabis genetics. Thousands of years of adaptation has created strains to express their best traits for survival in all geographical locations. Diverse habitats have required the plant to make accommodations to maintain survival, creating a conditioned array of cannabis varieties. All the more reason to further investigate the variability of strains by understanding phenotypes, genotypes and chemotypes. 

What are Genotypes?

There is no debate that cannabis is a plant making its function and form closely related to other flowering plants in our atmosphere. The plant is a living organism with a genetic code that stimulates adaptations to survive its environment. Genetic codes are inherited from past cannabis crossings or ancestors determining growth, appearance, and other characteristics. As new strains are birthed through cross-breeding, genotypes develop, which essentially means the “ingredients” for a strain’s individual internal sequences of DNA and RNA creating its unique characteristics. 

The genetic composition of the cannabis plant- called the genotype- acts as a blueprint or map for its genetics. It provides a range of growth possibilities to the plant. It also determines how the genetics evolve and change as they are passed down. Each cannabis strain carries a different genetic code and therefore different genotypes. Just like every living organism; plants, humans, animals, all comprise of genetic sequences that make us one of a kind.

What are Phenotypes?

Two things influence the structural formation of any given cannabis plant: genetics and environment. The physical expression of a genotype is referred to as a phenotype. The traits, such as, color, shape, smell, and resin production are influenced by the environment causing adaptations from the plant’s genetic code. Therefore the environment cannabis is grown in can greatly affect and/or evolve the plant’s genetic code.

Cannabis has progressed its predigre from generations of being grown wildly, stimulating evolutionary adaptations for maintaining survival in specific climate and environmental conditions. Today, cannabis plants, dependent on strain show different characteristics in appearance with: 

🌿 Indica adapted to cooler conditions and thrived in mountainous regions. Plants were commonly short and stocky with broad leaves.

🌿 Sativa plants grew tall with slender leaves in tropical jungle conditions.

Cannabis breeders have crossed these varieties even further resulting in the production of new hybrids widing the margin for phenotypes and genotypes. The diversity provides a choice of flavours, aromas, and effects. For top dollar, patients can purchase clone/ replications of plants harvested by growers with specific phenotype expressions to achieve consistent relief. However, we must consider, thanks to evolutionary needs and DNA, not all plants will produce the same chemical compounds with exact concentration at each harvest. Much like humans have siblings from identical origins, plants essentially have siblings too with their own unique genetic sequence! 

What are Chemotypes?

Cannabis breeders are now providing us a virtually endless selection of strains to choose. While most dispensaries sell products as indica, sativa, or hybrid products, it would be more appropriate to identify cannabis by its chemotypes. 

Cannabis strains will produce different effects depending on the mixtures and concentrations of cannabinoids present in a given plant. Chemotypes are the classification of different cannabis varieties based on their chemical constituents. Five different chemotypes have been identified as follows:

🪴 Type I: the “drug type” because of its high THC content and low CBD:THC ratio

🪴 Type II: the “intermediate,” consisting of near equal parts THC and CBD

🪴 Type III: the “fiber” or “non-drug type” is mainly CBD

🪴 Type IV: which is predominantly CBG, with some CBD present

🪴 Type V: material with undetectable amounts of any cannabinoids

Genotypes, Phenotypes, Chemotypes for Your Type

Modern day cannabis has evolved in many ways. While many talk about the potency of today’s cannabis, it is important to recognize how the plant genetics and cultivation environments affect the medicine. Hopefully this will increase your understanding of defining characteristics for each strain, the various subtle differences in its phenotypes, and therefore easier to try diverse strains and potencies to find what works best for you. Be sure to keep track!

Aizpurua-Olaizola O, Soydaner U, Öztürk E, Schibano D, Simsir Y, Navarro P, Etxebarria N, Usobiaga A. 2016. Evolution of the cannabinoid and terpene content during the growth of Cannabis sativa plants from different chemotypes. Journal of Natural Products 79: 324–331.

Basas-Jaumandreu J, De las Heras FXC. 2020. GC-MS metabolite profile and identification of unusual homologous cannabinoids in high potency Cannabis sativa. Planta Medica 86: 338–347.

Bayer PE, Golicz AA, Scheben A, Batley J, Edwards D. 2020. Plant pan-genomes are the new reference. Nature Plants 6: 914–920.

Sawler, J., Stout, J. M., Gardner, K. M., Hudson, D., Vidmar, J., Butler, L., Page, J. E., & Myles, S. (2015). The Genetic Structure of Marijuana and Hemp. PloS one, 10(8), e0133292. https://doi.org/10.1371/journal.pone.0133292

Schwabe, A.L., McGlaughlin, M.E. Genetic tools weed out misconceptions of strain reliability in Cannabis sativa: implications for a budding industry. J Cannabis Res 1, 3 (2019). https://doi.org/10.1186/s42238-019-0001-1

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Cannabis, Cannabinoids, and Your Body: Learn More About Your Medicine
LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Much of the recent scientific discoveries revealing the relationship between cannabis and our bodies involve the developing awareness and researched effects related to cannabinoids. This chemical compound is confounding researchers and patients alike. Naturally cannabinoids are found in only two places: obviously cannabis, and invertebrate animals- including mammals, birds, reptiles, and fish. 

Already sounding too sciency? Here is the thing- cannabis chemistry is meant to arm you with a basic knowledge of how cannabis affects the brain and body. So the better you understand your medicine, the more effective the remedy. Let’s make sense of this together… 

What are Cannabinoids?

Cannabinoids are a group of chemical compounds made up of 21 carbon atoms in a 3-ring structure. They bind to receptors throughout the brain and body. Aside from being the most mispronounced word in cannabinoid science- “kuh–nab–uh-noid”- they comprise approximately 100 of the 500 chemical compounds in cannabis, working together to provide a wide range of psychological and physiological effects.

Cannabinoids are neurotransmitters exerting their effects by interacting with specific cannabinoid receptors present on the surface of cells. The effects of cannabinoids depend on the targeted area of either the body or brain. They mediate communication between cells, allowing for immediate response to deficiencies or problems in our endocannabinoid system and halt unpleasant symptoms and physical complications. Simply put, cannabinoids activate receptors to maintain internal stability and health. 

While most cannabinoids are not intoxicating themselves, combinations of their presence can influence how each affects you. Different cannabinoids connect with or influence different receptors to produce different effects to achieve homeostasis or balance. 

Different Types of Cannabinoids

Now that we know what cannabinoids are and how to pronounce the word (😉), let’s break down the different types. Cannabinoids are produced not only in the cannabis plant but also in our bodies and they can be engineered in a lab. Crazy right!? As you may have previously thought, cannabinoids are groups of substances found only in the cannabis plant– well, let’s be real here, as much tetrahydrocannabinol (THC), cannabidiol (CBD), and their friends are important, they are not the stars of show here. Here more info about each kind:

🌿 phytocannabinoids or exogenous cannabinoids are compounds naturally existing in the cannabis sativa plant. If you know any Latin- “phyto” means “of a plant or relating to plants.” Hence the prefix relating this type of cannabinoid. Phytocannabinoids are made in the resin in the plant’s glandular trichomes on the surface of its leaves. For this reason, these cannabinoids are also referred to as “exogenous cannabinoids” as they are developed outside an organism.The plant has over 500 compounds, out of which over 100 belong to this class of cannabinoids. You may be familiar with some the more commonly occurring endocannabinoids:

🌿 tetrahydrocannabinol (THC)

🌿 cannabidiol (CBD)

🌿 cannabidiolic acid (CBDA) 

🌿 tetrahydrocannabinolic acid (THCA)

🌿 cannabinol (CBN)

🌿 cannabigerol (CBG)

🌿 cannabichromene (CBC)

🌿 tetrahydrocannabivarin (THCV)

One of the essential qualities of cannabinoids making them critical to treatment of physical and mental health diagnoses are their homeostatic qualities. When consumed, cannabinoids quickly enact the endocannabinoid system by attaching to the receptors influencing a response to target a symptom(s). They interact with the properties within these chemical compounds to produce effects such as mood enhancement, pain relief, anxiety decrease and stimulation of appetite. 

👤 endocannabinoids or endogenous cannabinoids are cannabinoids produced inside the body. When adding the Latin prefix “endo” – meaning internal or within- we are talking about cannabinoids created in your body. Yes, your very own body makes similar chemical compounds to the cannabis plants. Endocannabinoids are on-demand neurotransmitters, which are produced when needed and can work within seconds and disappear again.

Endocannabinoids lend themselves to rebalancing the most essential systems in the body, such as activators of the immune system. They are synthesized from fatty acids and respond locally from where they were produced. Just like phytocannabinoids, endocannabinoids interact with receptors to initiate a physical response. The two most commonly occurring endocannabinoids are:

👤 N-arachidonoylethanolamine – “anandamide” (AEA)

👤 2-arachidonoylglycerol (2-AG)

Research continues on the exact physiological mechanism promoting or triggering the binding of the receptors to the endocannabinoids. In the meantime, we will all hope our bodies maintain balance.

🧪 synthetic cannabinoids incorporate the commercial production of isolated cannabinoids and novel cannabinoid drugs made to enhance creations by nature. What am I talking about? Pharmaceuticals or cannabis-related compounds. While cannabis remains a Schedule 1 controlled substance, the Food and Drug Administration (FDA) has not approved cannabis for the treatment of any disease or condition, “synthetic cannabinoids” refers to cannabinoids that are synthesized in a lab to create new medicine.

However the FDA has approved one cannabis-derived drug product: 

🧪 Epidiolex (cannabidiol) for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in patients two years of age and older.

And three synthetic cannabis-related drug products: 

🧪 Marinol / Dronabinol / Syndros is used to treat loss of appetite and severe nausea and vomiting.

🧪 Nabilone or Cesamet used for chemotherapy-induced nausea/vomiting.

🧪 Sativex used as treatment for unresponsive spasticity in multiple sclerosis (MS) patients

These approved drug products are only available with a prescription from a licensed healthcare provider. As the laws and policies surrounding cannabis evolve with more research, we will undoubtedly see more cannabis derived and related medications from the pharmaceutical companies.

⚠️ In the meantime, there is also an illicit market for synthetic cannabis products to avoid the restriction placed on the legal market. These highly intoxicating and often very toxic designer drugs are sold under the names:

⚠️ Spice 

⚠️ K2

⚠️ herbal smoking blends

⚠️ synthetic marijauna 

These designer drugs are sprayed onto plant matter and commonly cause negative effects including palpitations, paranoia, intense anxiety, nausea, vomiting, confusion, poor coordination, and seizures. There have also been reports of a strong compulsion to re-dose, withdrawal symptoms, persistent cravings, and several deaths have been linked to synthetic cannabinoids. If you believe you have consumed counterfeit cannabis or CBD products and are concerned about negative effects, seek emergency medical care immediately.

In Conclusion

Phytocannabinoids from the plant mimic the naturally occurring endocannabinoids in our bodies. While synthetic cannabinoids are engineered to keep up with the natural production from plants and humans. Whether you choose to supplement your body’s natural process with cannabis or hemp, cannabinoids will continue to assist in finding balance. Just remember- as helpful as cannabis is, so is seeking professional help for any medical concern and staying mindful of the purpose of cannabis or cannabinoids use as it may indirectly postpone seeking treatment. 

Ahn K, et al. (2008). Enzymatic pathways that regulate endocannabinoid signaling in the nervous system. DOI: 1021/cr0782067

Alger BE. (2013). Getting high on the endocannabinoid system. ncbi.nlm.nih.gov/pmc/articles/PMC3997295

Atakan Z. (2012). Cannabis, a complex plant: different compounds and different effects on individuals. Therapeutic advances in psychopharmacology, 2(6), 241–254. https://doi.org/10.1177/2045125312457586

Fine, P. G., & Rosenfeld, M. J. (2013). The endocannabinoid system, cannabinoids, and pain. Rambam Maimonides medical journal, 4(4), e0022. https://doi.org/10.5041/RMMJ.10129

Gomez M, et al. (2008). Cannabinoid signaling system.
ncbi.nlm.nih.gov/pmc/articles/PMC2633685

Gorzkiewicz A, et al. (2018). Brain endocannabinoid signaling exhibits remarkable complexity. DOI: 1016/j.brainresbull.2018.06.012

Human endocannabinoid system. (n.d.). uclahealth.org/cannabis/human-endocannabinoid-system

Lu H-C. (2015). An introduction to the endogenous cannabinoid system. DOI: 1016/j.biopsych.2015.07.028

Nagarkatti, P., Pandey, R., Rieder, S. A., Hegde, V. L., & Nagarkatti, M. (2009). Cannabinoids as novel anti-inflammatory drugs. Future medicinal chemistry, 1(7), 1333–1349. https://doi.org/10.4155/fmc.09.93

Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J. (2020). Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC psychiatry, 20(1), 24. https://doi.org/10.1186/s12888-019-2409-8

Zou S, et al. (2018). Cannabinoid receptors and the endocannabinoid system: Signaling and function in the central nervous system. DOI: 3390/ijms19030833

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

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New PTSD study finds cannabis safe, but not as effective as assumed

Preliminary results from a long-awaited study indicate that cannabis appears to be a safe and well-tolerated treatment for patients managing post-traumatic stress disorder (PTSD), although researchers did not find strong signals of effectiveness.

The study, led by Marcel Bonn-Miller of the University of Pennsylvania and Sue Sisley of the Scottsdale Research Institute, was funded by a $2.2 million grant from the Colorado Department of Public Health and Environment (CDPHE) to the Multidisciplinary Association of Psychedelic Studies (MAPS). Researchers fought for seven years to obtain approval to conduct the study, and it took three more years to carry it out.

For years, many military veterans have used medical marijuana to manage the symptoms of PTSD. It has been extremely difficult to study the effectiveness of cannabis for PTSD, though, because of federal prohibition and the many roadblocks specifically established to discourage the study of the potential positive health benefits of cannabis. Sisley fought for years to get this study approved, and then struggled to obtain government-approved cannabis of sufficient quality to carry out the research.

76 veterans in the study

The study involved 76 military veterans with PTSD, mostly men between the ages of 24 and 77. Bonn-Miller and Sisley established a two-phase study; the results of the first phase were published in this week’s PLOS One paper.

In the first phase, the 76 veterans were divided into four cohorts. One group self-administered cannabis with 12% THC over three weeks. Another group received an 11% CBD product with minimal THC. A third group received a balanced THC-CBD product, with roughly 8% THC and 8% CBD. A fourth group received a placebo with almost zero active cannabinoids.

Participants were given 1.8 grams per day for 21 days. That’s about the amount of cannabis contained in two to three joints. After three weeks, the subjects stopped consuming cannabis completely for two weeks. Then they were re-randomized in the four cohorts.

No significant difference found

Researchers found little statistical difference between veterans who took the placebo and those given the THC and CBD mixtures. In fact, nearly half of the veterans who received a placebo believed they had been given active cannabis. The study’s authors cited “several confounding factors” that may have contributed to these results. 

They also wrote:

The study sample included participants with a history of cannabis use. The recruitment of active cannabis users might have increased the potential for biased responding. Given the topical nature of the current trial and its relevance for public policy on medical cannabis, participants might have been biased to report positive effects regardless of condition. Despite many participants already having experience with the drug, nearly half of those receiving placebo believed that they received active cannabis. Prior expectations about cannabis’ effects might explain why even those in the placebo condition reported larger than average reductions in PTSD symptoms after only 3 weeks of treatment.

Poor quality of government cannabis could be a factor

Rick Doblin, executive director of MAPS, the organization that facilitated the study, noted that “the difference between anecdotal reports” of the effectiveness of cannabis for PTSD “and these results may be the quality of the marijuana.”

The cannabis in the study’s first part was supplied by the National Institute on Drug Abuse (NIDA), which has the only license in the U.S. for the production of cannabis used in federally-regulated clinical trials.

The quality and potency of that research cannabis has been a major point of contention over the years. NIDA-supplied cannabis has been notoriously awful—some of the lowest-potency and poorest-quality marijuana to be found anywhere in North America. It took years for NIDA to begin growing strains that even approached commercial grade. And even then the agency fell short. A 12% THC strain is roughly half the potency of the product sold in most medical and adult-use dispensaries in 35 states today. When the research team tested the cannabis sent by NIDA, even the 12% strain came up short. It tested at only 9% THC.

“Research quality” cannabis sparked earlier controversy

Early on in the study, criticism over the poor quality and low potency of the NIDA-supplied cannabis prompted Johns Hopkins University to withdraw from the multi-year clinical trials. Despite criticism from cannabis researchers and some Congressional lawmakers, NIDA maintains a government monopoly on all cannabis used in federally-approved cannabis research.

“Higher quality cannabis flower suitable for Food and Drug Administration (FDA) approval is currently unavailable domestically due to restrictions on production imposed by the U.S. Department of Justice and Drug Enforcement Administration and must be imported,” Doblin said.

Moving on to the next phase of research

Sue Sisley, a medical doctor, president of the Scottsdale Research Institute and the study’s principal investigator, is moving ahead with the next phase of the study, with higher-quality and higher-potency imported cannabis. That cannabis is available to adults and patients in any of dozens of states, but federally-approved researchers can’t use it because of federal prohibition. So it must be imported from outside the United States.  

“Despite the absurd restrictions federal prohibitionists have placed on research for more than 50 years,” said Sisley, “we are squarely focused on launching further Phase 2 trials with imported cannabis of tested, higher potency, fresher flowers that will provide a valid comparison for the millions of Veterans and others with PTSD who are looking for new options.”

PTSD widespread in veteran communities

According to MAPS, about 6% to 10% of the general population, and up to 31% of U.S. veterans, have experienced some form of PTSD. Veterans groups advocating for more access to cannabis, meanwhile, are applauding the newly-published study.

“MAPS and Dr. Sue Sisley deserve a medal for the absolute intentional dysfunction they overcame to complete this study and publish its findings,” Sean Kiernan, president of the Weed for Warriors Project, said in an email to Leafly. “All someone has to do is look at the lack of quality cannabis provided by the Federal Government’s monopoly, NIDA, to understand our Government is not taking our healing seriously.”

“When science tells us cannabis is safe,” he added, “common-sense should tell everyone, cannabis is an amazing substitute for opioids, and other legal accessible substances that carry with them the side effects of addiction, overdose, and suicidal ideation. Is it any wonder why millions prefer cannabis over deadly pharmaceuticals and other harmful substances?  It simply is a safer substitute.”

Establishing cannabis as safe

Dale Schafer, a California attorney who specializes in cannabis law, and a Vietnam-era Navy veteran, pointed out that studies such as the MAPS clinical trials are necessary if there is ever to be federal approval of cannabis use for PTSD.

“However, for the multitude of veterans, and average citizens, suffering from PTSD, Stevie Wonder can see that cannabis is medically helpful and thousands of years of use show an incredible safety profile,” he told Leafly. “Let’s move quickly to Phase 3 so veterans can work with the VA directly and not have to play games like cannabis is radioactive.”

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This article written by Bruce Kennedy was originally posted on Leafly.com.

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

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Cannabis and Mental Health: Harm Reduction Strategies

There is a well-documented link between cannabis and the onset of psychosis in vulnerable individuals. Typically, guidelines recommend that people with a history of mental illness, either individually or in their family, should avoid cannabis at all costs. Approximately 1 in 5 Canadians and Americans experience a mental health condition each year, and approximately 1 in 33 Canadians will experience psychosis in their lifetime, with similar numbers in the States.But is abstinence the only option? Or might there be some middle ground, where people can consume cannabis while taking measures to protect themselves?

There is little consensus on the specifics of the complicated relationship between cannabis and mental health, although the association between cannabis use and mental illness is well-documented. Some experts staunchly insist that cannabis causes mental illness, while others believe the data reflects the fact that people with a predisposition to mental illness are more likely to be attracted to cannabis.

But what almost everyone can agree on is that people with a personal or familial history of mental illness, in particular, psychosis, should take action to reduce harm if they do choose to consume cannabis.

There are many choices that can reduce potential mental health risks of cannabis consumption.

What are the mental health risks of cannabis?

The main mental health risk of cannabis consumption is developing psychosis, the experience of losing contact with reality. The symptoms vary among individuals, but may include unusual thoughts, seeing or hearing things that are not there, and paranoid or delusional beliefs.

While THC can cause paranoia in people without mental illnesses, the evidence suggests that those who develop full-blown psychotic illness in response to cannabis use were likely predisposed to it in the first place.

There is also some evidence suggesting that people who have mental health vulnerabilities may be more likely to try cannabis, rather than cannabis causing their mental illness.

Depression and heavy use of cannabis are also associated, but similarly, it is unclear if the association is causal, or if shared factors may increase the likelihood of both cannabis consumption and depression.

Strategies for lower risk cannabis consumption

Most physicians recommend a person abstain from cannabis if they have a personal or family history of mental illness. If someone chooses to consume cannabis anyway, there are a few ways to reduce harm.

The Centre for Addictions and Mental Health (CAMH), along with Health Canada, has produced a set of lower risk cannabis use guidelines.

The guidelines explain that abstinence is the most effective way to avoid the psychiatric risks of cannabis. In addition, they suggest delaying the use of cannabis as long as possible, and ideally until after adolescence.

Dr. Romina Mizrahi, MD, professor of psychiatry at the University of Toronto, and director of the Focus on Youth Psychosis Prevention program at CAMH explains:

“The key issue, I think, here really has to do with brain development,” she says. “One would want to minimize use before the brain is developed. And I would usually say ideally until 24 or 25. But I mean, it has to be after the age of 21, for sure.”

The guidelines also recommend people opt for cannabis with lower THC content overall, and a higher CBD to THC ratio.

Dr. Mizrahi emphatically agrees.

“We know that THC is associated with psychotic experiences, and we also know it’s associated with abuse and dependence. So certainly I want to make that recommendation that when people have to choose, they attempt as much as possible to use a minimal THC content.”

Finally, the guidelines suggest that people with a family history of psychosis should not consume cannabis at all.

If you have a first-degree relative—a mother, father, brother, sister, or child—who has experienced a psychotic disorder, it is worth being extra cautious.

Your risk is higher the more closely you are related to the affected individual. For example, the risk of schizophrenia is 6.3x higher in those with an affected first-degree relative, and 2.4x higher in those with an affected second-degree relative. Second-degree relatives include aunts, uncles, nieces, nephews, half siblings, grandparents, and grandchildren.

Dr. Kim Lam, MD, a patient educator at Apollo Cannabis Clinics in Toronto, has some additional advice to offer.

Lam suggests patients with any history of mental illness use the “start low and go slow” rule. This means starting with a low dose of cannabis, and increasing it slowly to reduce the risk of side effects.

When asked about how cannabinoid content can impact a person’s experience, Lam’s clinical experience lines up with the CAMH guidelines.

“Cannabis with a higher CBD content and lower THC content can reduce harm in a mental health context,” Lam said.

“Because THC is psychoactive, and CBD has been shown to help diminish the side effects of THC, we often like to start patients on just CBD, and add THC only if needed.”

Importantly, people with mental health vulnerabilities who choose not to abstain from cannabis can still make choices to reduce the risk to their mental health.

Here are some harm reduction strategies for cannabis consumption:

      • Consider abstinence. Abstinence is the best way to avoid the mental health risks of cannabis consumption. Consider this more strongly if you have a close relative who is affected by psychosis.
      • Delay use until after adolescence (age 21). Cannabis is thought to affect teens’ brain development, which may account for some of the mental health risks.
      • If you choose to consume, select cannabis with lower THC content overall, and cannabis with a higher CBD to THC ratio. Avoid illicit cannabis, which is not tested.
      • Start low and go slow to reduce the risk of side effects. If you have a distressing mental experience while using cannabis, stop consuming it temporarily and seek help.
Leafly logo

This article written by Laura Tennant was originally posted on Leafly.com.

Chou, I. J., Kuo, C. F., Huang, Y. S., Grainge, M. J., Valdes, A. M., See, L. C., Yu, K. H., Luo, S. F., Huang, L. S., Tseng, W. Y., Zhang, W., & Doherty, M. (2017). Familial Aggregation and Heritability of Schizophrenia and Co-aggregation of Psychiatric Illnesses in Affected Families. Schizophrenia bulletin, 43(5), 1070–1078. https://doi.org/10.1093/schbul/sbw159

https://www.schizophrenia.ca/docs/SSC%20and%20SSCF%20Annual%20Report%20for%202017-2018.pdf

Louisa Degenhardt, Wayne Hall, Michael Lynskey. Exploring the association between cannabis use and depression. Addiction: 98 (11), 1471-1640, (November 2003).

Morrison, P., Zois, V., McKeown, D., Lee, T., Holt, D., Powell, J., . . . Murray, R. (2009). The acute effects of synthetic intravenous Δ9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychological Medicine, 39(10), 1607-1616. doi:10.1017/S0033291709005522

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

Medical Cannabis Users Beware! Drug Interactions You Need to Know About

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Brain

written by

Namen Namestein

Brain

reviewed by

Namen Namestein

If using cannabis while taking other medications has you questioning their interaction- I applaud your good thinking. Just like adding a new prescription to your daily medication regimen there is concern for possible drug interactions, which holds true of cannabis as well. Afterall, cannabis is medicine, though to avoid negative side effects and medication counteracting from prescription drugs, cannabis needs to be considered as a potential factor in causing those effects through its process of metabolization resulting in possible effects.

Now, let us break down medication interactions and what you may need to be more aware of when medicating with cannabis. We will review the different kinds of side effects, what to avoid to prevent them, certain kinds of medication you shouldn’t take with cannabis, and other other things to manage adverse drug interactions.

Types of Drug Interactions

As all drugs can cause an array of reactions- some benign and others serious- it is important to know about possible drug interactions. The effectiveness of drugs can be increased or decreased when combined with another drug or substance. These are the threes types of drug interactions take may be cause for concern:

💊 drug-drug interactions occur when two or more drugs react with each other, which includes prescription, over-the-counter, and illicit drugs. This is of utmost concern with drugs that have a narrow range between therapeutic and lethal doses.

💊 drug-food interactions occur when drugs react with foods, dietary supplements and/ or beverages. Some drugs may also interfere with the body’s ability to absorb nutrients. 

💊 drug-disease interactions occur when a drug exacerbates or worsen an existing medical condition. High risk conditions for drug interactions include:

✱ kidney disease 
✱ liver disease 
✱ diabetes 
✱ asthma
✱ cardiac problems
✱ epilepsy
✱ high blood pressure
✱ low blood pressure 

Types of Drug Interaction Effects

Drug interaction predictors enable risk assessment of drugs. The dreaded side effects of medication are actually broken down into three types and it is important to understand the difference between each to know how best to manage them. Here are the definitions and  differentiating factors of additive, synergistic, and antagonistic effects:

✳️ additive effects of drugs produce a reaction created by causative factors acting together as the sum of their individual effects. Simply put- that means the two chemicals work together to equal the sum of their parts. The impact of the two or more drugs together adds scientific value to the predicted outcome. Elements essentially added to each other’s intended outcome chemically and biologically.

✳️ synergistic effects refers to the effect of two chemicals interacting creating a greater reaction than using one individually. The interaction adds to the strength to the effect of the medicine. When chemicals are synergistic, the potential hazards of the chemicals should be considered and re-evaluated.

✳️ antagonistic effects speaks to the instance when two or more drugs are combined to produce a weaker, decreased, or opposite effect on the body. Drug antagonism may block or reduce the effectiveness of one or more drugs.

Cannabis Drug Interactions

If you plan to use cannabis medicinally, chances are you are already on a course of other medication. Common uses of cannabis often include diagnoses of cancer, chronic pain, epilepsy/seizures, nausea and vomiting, muscle spasms, inflammatory conditions, Alzheimer’s, and Parkinson’s diseases. The wide range of uses increases the likelihood of potential drug interactions as most of these diagnoses affect individuals who require numerous medications combinations due to age or illness. All the more reason to review the drug interaction considerations when medicating with cannabis.

The following drug-drug interactions are cause for concern when using cannabis

🚩 opioids may allow for lower opioid doses while reducing risk of dependency and fewer side effects. 

🚩 sedatives (benzodiazepines, antidepressants, barbiturates, narcotics) produces an additive effect with cannabis increasing sedative effects.

🚩 blood sugar medication could be a risk when cannabis is combined as glucose levels could significantly drop causing a medical emergency.

🚩 blood pressure medication may compound effects by activating receptors to induces a cardiovascular stress response that can elevate cardiac oxygen consumption while reducing blood flow in coronary arteries.

🚩 blood thinning medication effectiveness’ may be augmented possibly slowing down the metabolism of these drugs. 

🚩 heart rhythm medication with cannabis may amplify its affect and change the heart rhythm.

🚩 thyroid medication may compete with cannabis in the cytochrome P450 pathways to be metabolized.

🚩 seizure medication may induce seizure if not properly used with cannabis.

🚩 alcohol …uh, yeah. Alcohol is a drug. When combined with cannabis these substances may result in very different reactions depending on many variables including which one you use first and how you consume them. 

There are some drugs that are of utmost concern as their interaction with cannabis could be fatal. Potentially serious drug interactions include:

⚠️ warfarin

⚠️ amiodarone

⚠️ levothyroxine

⚠️ clobazam

⚠️ lamotrigine

⚠️ valproate

Tips to avoid adverse effects from drug interactions

There is clearly lots to know to mitigate the risks involved with drug interactions. To best prepare yourself for medical cannabis use and to decrease the risk of interactions, consider these tips: 

🔹 Know your own medicines. Be sure to read about the medication prescribed and any interactions to consider.

🔹 When you see your doctor, be sure to inform them about all the drugs you are taking. These should include over-the-counter medications, vitamins, dietary supplements, herbal remedies, cannabis, CBD, and any medicinal substance.

🔹 Keep your list of medications up to date, which is particularly important if you visit more than one doctor or pharmacy.

🔹 Ask your doctor or pharmacist what to avoid- medications / food/ beverages…

🔹 Take medication as instructed and learn about possible side effects. Be sure to make your medical providers aware of any side effects you experience.

🔹 Review your medications regularly to eliminate unnecessary ones as interactions increase when medication variety increases.

🔹 Do your own research! Not every doctor and/or pharmacist is up on the latest cannabis info. You, too, can take some responsibility for your treatment. Consider looking up your medicine interactions with MedScape, Drugbank, and any other online resources offering updated info on pharmaceuticals + cannabis.

In Conclusion

Cannabis has the potential to interact with many medications, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be administered in combination with cannabis while others may need modification or reduction to prevent serious issues. Cannabis may increase or decrease the effectiveness or potency of other drugs. Though always consult your doctor before tampering with your regimen. 

All interactions considered, everyone should inform healthcare professionals should be informed of any condition(s) and/ or medications / dietary supplements being administered during a doctor’s visit or when purchasing medicines at the pharmacy. Yup, that means cannabis, CBD, and any form of chemical compound derived from it. Cannabis, like every other medication, must be considered when ANY medical professional is treating you. Stay safe potential cannabis users!

https://news.gallup.com/businessjournal/170696/win-natural-talent-additive-effects.aspx

https://www.fda.gov/drugs/information-consumers-and-patients-drugs/you-age-you-and-your-medicines

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Lukas SE, Benedikt R, Mendelson JH, Kouri E, Sholar M, Amass L. Marihuana attenuates the rise in plasma ethanol levels in human subjects. Neuropsychopharmacology. 1992 Aug;7(1):77-81. PMID: 1326277.

Yurasek, A.M., Aston, E.R. & Metrik, J. Co-use of Alcohol and Cannabis: A Review. Curr Addict Rep 4, 184–193 (2017). https://doi.org/10.1007/s40429-017-0149-8

Ramaekers, J. G., Theunissen, E. L., de Brouwer, M., Toennes, S. W., Moeller, M. R., & Kauert, G. (2011). Tolerance and cross-tolerance to neurocognitive effects of THC and alcohol in heavy cannabis users. Psychopharmacology, 214(2), 391–401. https://doi.org/10.1007/s00213-010-2042-1

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

A proclame to fame is the common phrase; “I have such a type..” which can link to a magnitude of preferences in someone’s life. Though for some, when it comes to “a type” of strain found in cannabis, the pressure is on to pursue the relief again. Though here is the problem, solely searching for this strain without considering the brand can lead to a completely different experience than before. You may notice differences in the flower with the smell, taste and/or burn, so to avoid this for the future, we must consider the key three factors to successful types of strains:

🧬 phenotypes

🧬 genotypes

🧬 chemotypes 

When we consider the lineage of cannabis, which just like any plant, has been adapting over time to accommodate its habitat, we are left to dive deeper into education on cannabis genetics. Thousands of years of adaptation has created strains to express their best traits for survival in all geographical locations. Diverse habitats have required the plant to make accommodations to maintain survival, creating a conditioned array of cannabis varieties. All the more reason to further investigate the variability of strains by understanding phenotypes, genotypes and chemotypes. 

What are Genotypes?

There is no debate that cannabis is a plant making its function and form closely related to other flowering plants in our atmosphere. The plant is a living organism with a genetic code that stimulates adaptations to survive its environment. Genetic codes are inherited from past cannabis crossings or ancestors determining growth, appearance, and other characteristics. As new strains are birthed through cross-breeding, genotypes develop, which essentially means the “ingredients” for a strain’s individual internal sequences of DNA and RNA creating its unique characteristics. 

The genetic composition of the cannabis plant- called the genotype- acts as a blueprint or map for its genetics. It provides a range of growth possibilities to the plant. It also determines how the genetics evolve and change as they are passed down. Each cannabis strain carries a different genetic code and therefore different genotypes. Just like every living organism; plants, humans, animals, all comprise of genetic sequences that make us one of a kind.

What are Phenotypes?

Two things influence the structural formation of any given cannabis plant: genetics and environment. The physical expression of a genotype is referred to as a phenotype. The traits, such as, color, shape, smell, and resin production are influenced by the environment causing adaptations from the plant’s genetic code. Therefore the environment cannabis is grown in can greatly affect and/or evolve the plant’s genetic code.

Cannabis has progressed its predigre from generations of being grown wildly, stimulating evolutionary adaptations for maintaining survival in specific climate and environmental conditions. Today, cannabis plants, dependent on strain show different characteristics in appearance with: 

🌿 Indica adapted to cooler conditions and thrived in mountainous regions. Plants were commonly short and stocky with broad leaves.

🌿 Sativa plants grew tall with slender leaves in tropical jungle conditions.

Cannabis breeders have crossed these varieties even further resulting in the production of new hybrids widing the margin for phenotypes and genotypes. The diversity provides a choice of flavours, aromas, and effects. For top dollar, patients can purchase clone/ replications of plants harvested by growers with specific phenotype expressions to achieve consistent relief. However, we must consider, thanks to evolutionary needs and DNA, not all plants will produce the same chemical compounds with exact concentration at each harvest. Much like humans have siblings from identical origins, plants essentially have siblings too with their own unique genetic sequence! 

What are Chemotypes?

Cannabis breeders are now providing us a virtually endless selection of strains to choose. While most dispensaries sell products as indica, sativa, or hybrid products, it would be more appropriate to identify cannabis by its chemotypes. 

Cannabis strains will produce different effects depending on the mixtures and concentrations of cannabinoids present in a given plant. Chemotypes are the classification of different cannabis varieties based on their chemical constituents. Five different chemotypes have been identified as follows:

🪴 Type I: the “drug type” because of its high THC content and low CBD:THC ratio

🪴 Type II: the “intermediate,” consisting of near equal parts THC and CBD

🪴 Type III: the “fiber” or “non-drug type” is mainly CBD

🪴 Type IV: which is predominantly CBG, with some CBD present

🪴 Type V: material with undetectable amounts of any cannabinoids

Genotypes, Phenotypes, Chemotypes for Your Type

Modern day cannabis has evolved in many ways. While many talk about the potency of today’s cannabis, it is important to recognize how the plant genetics and cultivation environments affect the medicine. Hopefully this will increase your understanding of defining characteristics for each strain, the various subtle differences in its phenotypes, and therefore easier to try diverse strains and potencies to find what works best for you. Be sure to keep track!

Aizpurua-Olaizola O, Soydaner U, Öztürk E, Schibano D, Simsir Y, Navarro P, Etxebarria N, Usobiaga A. 2016. Evolution of the cannabinoid and terpene content during the growth of Cannabis sativa plants from different chemotypes. Journal of Natural Products 79: 324–331.

Basas-Jaumandreu J, De las Heras FXC. 2020. GC-MS metabolite profile and identification of unusual homologous cannabinoids in high potency Cannabis sativa. Planta Medica 86: 338–347.

Bayer PE, Golicz AA, Scheben A, Batley J, Edwards D. 2020. Plant pan-genomes are the new reference. Nature Plants 6: 914–920.

Sawler, J., Stout, J. M., Gardner, K. M., Hudson, D., Vidmar, J., Butler, L., Page, J. E., & Myles, S. (2015). The Genetic Structure of Marijuana and Hemp. PloS one, 10(8), e0133292. https://doi.org/10.1371/journal.pone.0133292

Schwabe, A.L., McGlaughlin, M.E. Genetic tools weed out misconceptions of strain reliability in Cannabis sativa: implications for a budding industry. J Cannabis Res 1, 3 (2019). https://doi.org/10.1186/s42238-019-0001-1

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

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Cannabis, Cannabinoids, and Your Body: Learn More About Your Medicine
LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

LJG 2021

written by

Laura Geftman, LCSW

Hannah Sadock, MS

reviewed by

Hannah Sadock, MS

Much of the recent scientific discoveries revealing the relationship between cannabis and our bodies involve the developing awareness and researched effects related to cannabinoids. This chemical compound is confounding researchers and patients alike. Naturally cannabinoids are found in only two places: obviously cannabis, and invertebrate animals- including mammals, birds, reptiles, and fish. 

Already sounding too sciency? Here is the thing- cannabis chemistry is meant to arm you with a basic knowledge of how cannabis affects the brain and body. So the better you understand your medicine, the more effective the remedy. Let’s make sense of this together… 

What are Cannabinoids?

Cannabinoids are a group of chemical compounds made up of 21 carbon atoms in a 3-ring structure. They bind to receptors throughout the brain and body. Aside from being the most mispronounced word in cannabinoid science- “kuh–nab–uh-noid”- they comprise approximately 100 of the 500 chemical compounds in cannabis, working together to provide a wide range of psychological and physiological effects.

Cannabinoids are neurotransmitters exerting their effects by interacting with specific cannabinoid receptors present on the surface of cells. The effects of cannabinoids depend on the targeted area of either the body or brain. They mediate communication between cells, allowing for immediate response to deficiencies or problems in our endocannabinoid system and halt unpleasant symptoms and physical complications. Simply put, cannabinoids activate receptors to maintain internal stability and health. 

While most cannabinoids are not intoxicating themselves, combinations of their presence can influence how each affects you. Different cannabinoids connect with or influence different receptors to produce different effects to achieve homeostasis or balance. 

Different Types of Cannabinoids

Now that we know what cannabinoids are and how to pronounce the word (😉), let’s break down the different types. Cannabinoids are produced not only in the cannabis plant but also in our bodies and they can be engineered in a lab. Crazy right!? As you may have previously thought, cannabinoids are groups of substances found only in the cannabis plant– well, let’s be real here, as much tetrahydrocannabinol (THC), cannabidiol (CBD), and their friends are important, they are not the stars of show here. Here more info about each kind:

🌿 phytocannabinoids or exogenous cannabinoids are compounds naturally existing in the cannabis sativa plant. If you know any Latin- “phyto” means “of a plant or relating to plants.” Hence the prefix relating this type of cannabinoid. Phytocannabinoids are made in the resin in the plant’s glandular trichomes on the surface of its leaves. For this reason, these cannabinoids are also referred to as “exogenous cannabinoids” as they are developed outside an organism.The plant has over 500 compounds, out of which over 100 belong to this class of cannabinoids. You may be familiar with some the more commonly occurring endocannabinoids:

🌿 tetrahydrocannabinol (THC)

🌿 cannabidiol (CBD)

🌿 cannabidiolic acid (CBDA) 

🌿 tetrahydrocannabinolic acid (THCA)

🌿 cannabinol (CBN)

🌿 cannabigerol (CBG)

🌿 cannabichromene (CBC)

🌿 tetrahydrocannabivarin (THCV)

One of the essential qualities of cannabinoids making them critical to treatment of physical and mental health diagnoses are their homeostatic qualities. When consumed, cannabinoids quickly enact the endocannabinoid system by attaching to the receptors influencing a response to target a symptom(s). They interact with the properties within these chemical compounds to produce effects such as mood enhancement, pain relief, anxiety decrease and stimulation of appetite. 

👤 endocannabinoids or endogenous cannabinoids are cannabinoids produced inside the body. When adding the Latin prefix “endo” – meaning internal or within- we are talking about cannabinoids created in your body. Yes, your very own body makes similar chemical compounds to the cannabis plants. Endocannabinoids are on-demand neurotransmitters, which are produced when needed and can work within seconds and disappear again.

Endocannabinoids lend themselves to rebalancing the most essential systems in the body, such as activators of the immune system. They are synthesized from fatty acids and respond locally from where they were produced. Just like phytocannabinoids, endocannabinoids interact with receptors to initiate a physical response. The two most commonly occurring endocannabinoids are:

👤 N-arachidonoylethanolamine – “anandamide” (AEA)

👤 2-arachidonoylglycerol (2-AG)

Research continues on the exact physiological mechanism promoting or triggering the binding of the receptors to the endocannabinoids. In the meantime, we will all hope our bodies maintain balance.

🧪 synthetic cannabinoids incorporate the commercial production of isolated cannabinoids and novel cannabinoid drugs made to enhance creations by nature. What am I talking about? Pharmaceuticals or cannabis-related compounds. While cannabis remains a Schedule 1 controlled substance, the Food and Drug Administration (FDA) has not approved cannabis for the treatment of any disease or condition, “synthetic cannabinoids” refers to cannabinoids that are synthesized in a lab to create new medicine.

However the FDA has approved one cannabis-derived drug product: 

🧪 Epidiolex (cannabidiol) for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in patients two years of age and older.

And three synthetic cannabis-related drug products: 

🧪 Marinol / Dronabinol / Syndros is used to treat loss of appetite and severe nausea and vomiting.

🧪 Nabilone or Cesamet used for chemotherapy-induced nausea/vomiting.

🧪 Sativex used as treatment for unresponsive spasticity in multiple sclerosis (MS) patients

These approved drug products are only available with a prescription from a licensed healthcare provider. As the laws and policies surrounding cannabis evolve with more research, we will undoubtedly see more cannabis derived and related medications from the pharmaceutical companies.

⚠️ In the meantime, there is also an illicit market for synthetic cannabis products to avoid the restriction placed on the legal market. These highly intoxicating and often very toxic designer drugs are sold under the names:

⚠️ Spice 

⚠️ K2

⚠️ herbal smoking blends

⚠️ synthetic marijauna 

These designer drugs are sprayed onto plant matter and commonly cause negative effects including palpitations, paranoia, intense anxiety, nausea, vomiting, confusion, poor coordination, and seizures. There have also been reports of a strong compulsion to re-dose, withdrawal symptoms, persistent cravings, and several deaths have been linked to synthetic cannabinoids. If you believe you have consumed counterfeit cannabis or CBD products and are concerned about negative effects, seek emergency medical care immediately.

In Conclusion

Phytocannabinoids from the plant mimic the naturally occurring endocannabinoids in our bodies. While synthetic cannabinoids are engineered to keep up with the natural production from plants and humans. Whether you choose to supplement your body’s natural process with cannabis or hemp, cannabinoids will continue to assist in finding balance. Just remember- as helpful as cannabis is, so is seeking professional help for any medical concern and staying mindful of the purpose of cannabis or cannabinoids use as it may indirectly postpone seeking treatment. 

Ahn K, et al. (2008). Enzymatic pathways that regulate endocannabinoid signaling in the nervous system. DOI: 1021/cr0782067

Alger BE. (2013). Getting high on the endocannabinoid system. ncbi.nlm.nih.gov/pmc/articles/PMC3997295

Atakan Z. (2012). Cannabis, a complex plant: different compounds and different effects on individuals. Therapeutic advances in psychopharmacology, 2(6), 241–254. https://doi.org/10.1177/2045125312457586

Fine, P. G., & Rosenfeld, M. J. (2013). The endocannabinoid system, cannabinoids, and pain. Rambam Maimonides medical journal, 4(4), e0022. https://doi.org/10.5041/RMMJ.10129

Gomez M, et al. (2008). Cannabinoid signaling system.
ncbi.nlm.nih.gov/pmc/articles/PMC2633685

Gorzkiewicz A, et al. (2018). Brain endocannabinoid signaling exhibits remarkable complexity. DOI: 1016/j.brainresbull.2018.06.012

Human endocannabinoid system. (n.d.). uclahealth.org/cannabis/human-endocannabinoid-system

Lu H-C. (2015). An introduction to the endogenous cannabinoid system. DOI: 1016/j.biopsych.2015.07.028

Nagarkatti, P., Pandey, R., Rieder, S. A., Hegde, V. L., & Nagarkatti, M. (2009). Cannabinoids as novel anti-inflammatory drugs. Future medicinal chemistry, 1(7), 1333–1349. https://doi.org/10.4155/fmc.09.93

Sarris, J., Sinclair, J., Karamacoska, D., Davidson, M., & Firth, J. (2020). Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC psychiatry, 20(1), 24. https://doi.org/10.1186/s12888-019-2409-8

Zou S, et al. (2018). Cannabinoid receptors and the endocannabinoid system: Signaling and function in the central nervous system. DOI: 3390/ijms19030833

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HEY NEWBIES- START HERE!

KEEP IN MIND

Stay calm. Canna-curious is cool! But collect some info first.
If you are:

  • under 25 years old
  • taking any medication
  • at risk for heart disease
  • family history of psychosis
  • family history of mood disorders
  • family history of addiction

…please be sure to consult a medical or mental health professional.

NAVIAGTE

EXPLORE

New PTSD study finds cannabis safe, but not as effective as assumed

Preliminary results from a long-awaited study indicate that cannabis appears to be a safe and well-tolerated treatment for patients managing post-traumatic stress disorder (PTSD), although researchers did not find strong signals of effectiveness.

The study, led by Marcel Bonn-Miller of the University of Pennsylvania and Sue Sisley of the Scottsdale Research Institute, was funded by a $2.2 million grant from the Colorado Department of Public Health and Environment (CDPHE) to the Multidisciplinary Association of Psychedelic Studies (MAPS). Researchers fought for seven years to obtain approval to conduct the study, and it took three more years to carry it out.

For years, many military veterans have used medical marijuana to manage the symptoms of PTSD. It has been extremely difficult to study the effectiveness of cannabis for PTSD, though, because of federal prohibition and the many roadblocks specifically established to discourage the study of the potential positive health benefits of cannabis. Sisley fought for years to get this study approved, and then struggled to obtain government-approved cannabis of sufficient quality to carry out the research.

76 veterans in the study

The study involved 76 military veterans with PTSD, mostly men between the ages of 24 and 77. Bonn-Miller and Sisley established a two-phase study; the results of the first phase were published in this week’s PLOS One paper.

In the first phase, the 76 veterans were divided into four cohorts. One group self-administered cannabis with 12% THC over three weeks. Another group received an 11% CBD product with minimal THC. A third group received a balanced THC-CBD product, with roughly 8% THC and 8% CBD. A fourth group received a placebo with almost zero active cannabinoids.

Participants were given 1.8 grams per day for 21 days. That’s about the amount of cannabis contained in two to three joints. After three weeks, the subjects stopped consuming cannabis completely for two weeks. Then they were re-randomized in the four cohorts.

No significant difference found

Researchers found little statistical difference between veterans who took the placebo and those given the THC and CBD mixtures. In fact, nearly half of the veterans who received a placebo believed they had been given active cannabis. The study’s authors cited “several confounding factors” that may have contributed to these results. 

They also wrote:

The study sample included participants with a history of cannabis use. The recruitment of active cannabis users might have increased the potential for biased responding. Given the topical nature of the current trial and its relevance for public policy on medical cannabis, participants might have been biased to report positive effects regardless of condition. Despite many participants already having experience with the drug, nearly half of those receiving placebo believed that they received active cannabis. Prior expectations about cannabis’ effects might explain why even those in the placebo condition reported larger than average reductions in PTSD symptoms after only 3 weeks of treatment.

Poor quality of government cannabis could be a factor

Rick Doblin, executive director of MAPS, the organization that facilitated the study, noted that “the difference between anecdotal reports” of the effectiveness of cannabis for PTSD “and these results may be the quality of the marijuana.”

The cannabis in the study’s first part was supplied by the National Institute on Drug Abuse (NIDA), which has the only license in the U.S. for the production of cannabis used in federally-regulated clinical trials.

The quality and potency of that research cannabis has been a major point of contention over the years. NIDA-supplied cannabis has been notoriously awful—some of the lowest-potency and poorest-quality marijuana to be found anywhere in North America. It took years for NIDA to begin growing strains that even approached commercial grade. And even then the agency fell short. A 12% THC strain is roughly half the potency of the product sold in most medical and adult-use dispensaries in 35 states today. When the research team tested the cannabis sent by NIDA, even the 12% strain came up short. It tested at only 9% THC.

“Research quality” cannabis sparked earlier controversy

Early on in the study, criticism over the poor quality and low potency of the NIDA-supplied cannabis prompted Johns Hopkins University to withdraw from the multi-year clinical trials. Despite criticism from cannabis researchers and some Congressional lawmakers, NIDA maintains a government monopoly on all cannabis used in federally-approved cannabis research.

“Higher quality cannabis flower suitable for Food and Drug Administration (FDA) approval is currently unavailable domestically due to restrictions on production imposed by the U.S. Department of Justice and Drug Enforcement Administration and must be imported,” Doblin said.

Moving on to the next phase of research

Sue Sisley, a medical doctor, president of the Scottsdale Research Institute and the study’s principal investigator, is moving ahead with the next phase of the study, with higher-quality and higher-potency imported cannabis. That cannabis is available to adults and patients in any of dozens of states, but federally-approved researchers can’t use it because of federal prohibition. So it must be imported from outside the United States.  

“Despite the absurd restrictions federal prohibitionists have placed on research for more than 50 years,” said Sisley, “we are squarely focused on launching further Phase 2 trials with imported cannabis of tested, higher potency, fresher flowers that will provide a valid comparison for the millions of Veterans and others with PTSD who are looking for new options.”

PTSD widespread in veteran communities

According to MAPS, about 6% to 10% of the general population, and up to 31% of U.S. veterans, have experienced some form of PTSD. Veterans groups advocating for more access to cannabis, meanwhile, are applauding the newly-published study.

“MAPS and Dr. Sue Sisley deserve a medal for the absolute intentional dysfunction they overcame to complete this study and publish its findings,” Sean Kiernan, president of the Weed for Warriors Project, said in an email to Leafly. “All someone has to do is look at the lack of quality cannabis provided by the Federal Government’s monopoly, NIDA, to understand our Government is not taking our healing seriously.”

“When science tells us cannabis is safe,” he added, “common-sense should tell everyone, cannabis is an amazing substitute for opioids, and other legal accessible substances that carry with them the side effects of addiction, overdose, and suicidal ideation. Is it any wonder why millions prefer cannabis over deadly pharmaceuticals and other harmful substances?  It simply is a safer substitute.”

Establishing cannabis as safe

Dale Schafer, a California attorney who specializes in cannabis law, and a Vietnam-era Navy veteran, pointed out that studies such as the MAPS clinical trials are necessary if there is ever to be federal approval of cannabis use for PTSD.

“However, for the multitude of veterans, and average citizens, suffering from PTSD, Stevie Wonder can see that cannabis is medically helpful and thousands of years of use show an incredible safety profile,” he told Leafly. “Let’s move quickly to Phase 3 so veterans can work with the VA directly and not have to play games like cannabis is radioactive.”

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This article written by Bruce Kennedy was originally posted on Leafly.com.

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